Ep 326 - East Palestine:"I Have a Client Who . . ."Pathology Conversations with Ruth Werner

0:00:01.4 Ruth Werner: Hello, I Have a Client Who listeners. Ruth Werner here, and I'm so excited to let you know that my library of online self-paced continuing education courses has just expanded. I now have a two-hour ethics course called A Doctor's Note is Not Good Enough and What is Better. This NCBTMB approved course goes into why a doctor's permission or approval or even a prescription doesn't provide the legal or safety protection you might think it does. Then we look at how to start useful conversations with healthcare providers that will actually get us to safe and effective massage for our clients with complex conditions. Visit my website at ruthwerner.com for more information and to register for A Doctor's Note is Not Good Enough, and what is better.

0:00:52.4 RW: Introducing Back Jam. Held online, the first four Mondays in May 2023, and hosted by the Massage Mentor Institute. This is the fourth event in a series of workshops focused on a single region of the body. We've gathered the following industry leaders Til Luchau, James Waslaski, Tom Myers, Diane Lee, Paul Kelly, Sue Hitzmann, Whitney Lowe, Aubrey and Alison Gowing, Allison Denney, Judith Aston, Benny Vaughn, Heath and Nicole Reed, and Ruth Werner. Sign up for the Back Jam sponsored by ABMP at themassagementorinstitute.com.

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0:01:43.3 RW: Hi, and welcome to I Have a Client Who pathology conversations with Ruth Werner, the podcast where I will discuss your real life stories about clients with conditions that are perplexing or confusing. I'm Ruth Werner, author of A Massage Therapist's Guide to Pathology, and I have spent decades studying, writing about and teaching about where massage therapy intersects with diseases and conditions that might limit our client's health. We almost always have something good to offer even with our most challenged clients, but we need to figure out a way to do that safely, effectively and within our scope of practice. And sometimes, as we have all learned, that is harder than it looks. Today's I Have a Client Who story comes from a massage therapist whose location will be obvious and they have a question that will capture your attention, I just about guarantee. This also ties to another recent I Have a Client Who story that riled me up a bit. So we're in for another super fun ride, or should I say super fund site, and here is what our contributor sent.

0:02:56.2 RW: Ohio LMT here. I'm sure most of you have heard about the horrific chemical spill that happened in East Palestine. I'm wondering about what contra-indications for massage there are in regards to chemical exposure. Can the people who are exposed safely receive massage therapy? Should I be protecting myself during sessions? How would you handle these clients. People in East Palestine are searching for ways to support anxiety and stress relief during this time. My heart says to donate a few massages, but then I started wondering if I would actually be doing a disservice to those who have been affected. It's so hard to say how massage may change the way these chemicals are metabolized. Thinking of people as contaminated or a contamination risk has been difficult for me, but I want to do the right thing for everyone involved. I need to find a tactful way to screen them and weed out people who have clear contra-indications. I may still try to donate some massages. I think the biggest reported problem has been skin rashes, which are obviously a contra-indication. I might just take this one session at a time and see how it goes. Feel free to use this on your podcast.

0:04:08.1 RW: I replied saying, "Thanks so much for sharing. I haven't looked into this yet, and I didn't know rashes were a problem, obviously they are. Regarding speeding up metabolism, I don't think you could have much influence at this point unless your client is maybe someone who's working at the site. In that case, I'd say pull back to the best stress reducing, least circulatory type message you can do until your person's health situation is more stable. Thank you for your service in this setting, and for now, less is more." If you are a regular listener to I Have a Client Who, you might remember that I did an episode about working with the children and maybe even grandchildren of people who were exposed to Agent Orange in the 1970s. The key issue in that situation is that the poisons in Agent Orange were long-lasting and could alter genetic information so that mutations were passed to future generations. Obviously, we don't know if this will be the case for people exposed to the substances released in the train derailment, fire and subsequent controlled burn of toxins in East Palestine, Ohio. We also don't know about their long-term risks for other health challenges, and we'll come back to that in a bit.

0:05:20.9 RW: If you've been following the situation, I don't have anything new to add other than what you've heard already. But if this hasn't been on your radar, I wanna give us just a tiny bit of information about what happened and what we know for sure about health risks and about what we don't know yet. And then I'll talk about options for this wonderful massage therapist who wants to help. Spoiler alert, it's probably fine, but there might be a few things to check in on. I'll tell you what though, putting this information together has taken me to sources I have never used before. In our show notes, you will find links to articles from Scientific American and Stat News that's not new. But also I have links to NPR, NBC News, and I kid you not, Men's Health. And it was a good article. Check it out. So on February 3rd 2023, a train derailed Near East Palestine, Ohio. About 50 cars, some of them carrying toxic materials, were involved. The derailment started a fire, which spewed a lot of poisonous muck into the air. We've all seen the pictures. Plus it threatened to explode other cars full of dangerous chemicals.

0:06:32.4 RW: So on February 6, after evacuating the area, officials purposely released some of those chemicals into the air and some into a trench where they were burned off. At this point, the main chemical of concern is vinyl chloride. That's a key ingredient, when it's inert in PVC pipes. But when vinyl chloride burns, it breaks into two really bad things. Phosgene, which has historical use in chemical warfare in World War One, and hydrogen chloride. When someone inhales hydrogen chloride, it turns into hydrochloric acid in the lungs. But here's the good news, and really, it is good news. Both phosgene and hydrogen chloride are short-lived chemicals. They break down quickly and then pose no further threats. However, not all of the vinyl chloride on the train was dispersed in this way. And it, along with some other chemicals, and you know how I feel about chemistry, it's just not my jam, they are still being released into the air, and surface soil, and water.

0:07:39.0 RW: And here's the real kicker. All of those chemicals are irritants to humans, we know that. But what we don't know is how combining these chemicals in the air and the water and the soil will interact. We don't know how toxic or non-toxic it is. It is a whole new phenomenon. And here's another unknown. Dioxins and P-F-A-S, PFAS, could also be part of the toxic stew that might affect people near East Palestine, Ohio, or people near the hazardous waste disposal sites where the contaminated soil and liquid from the train derailment have been taken. What are dioxins and PFAS, I hear you ask? Well, dioxins are extremely long-lasting chemicals that can contaminate water and soil for decades. They can get into plants and livestock, they cause cancer and genetic damage, and we talked about this in the episode on Agent Orange. And here is from an article in The Guardian. Dioxins could be in the East Palestine region's air, homes, water, and soil, and could get into crops and livestock. Food is humans main exposure route. As of this recording, the EPA is not testing for dioxins.

0:09:02.0 RW: Hi, I'm just breaking in with a tiny update. As of March 2nd, the EPA is now calling on Norfolk Southern, the train company responsible for this accident, to test for dioxins. No word yet on any details about timing or remediation plans. And PFAS, P-F-A-S, are per-and polyfluoroalkyl substances. This is a group of chemicals that are used to make fluoropolymer coatings and products that resist heat, oil, stains, grease, and water. They are also used in firefighting foam. The CDC PFAS fact sheet goes on to say that PFAS are a concern because they do not break down in the environment, they can move through soils and contaminate drinking water sources, and they can build up or bioaccumulate in fish and wildlife. We don't really know the consequences of PFAS bioaccumulation in humans, but in animals it is associated with serious problems affecting several body systems. So there are some of the long-term health-related things we're looking at regarding the East Palestine train derailment.

0:10:18.3 RW: And while no deaths or injuries have been attributed specifically to this accident, we won't know for some time to come about what all these chemical releases and interactions in the environment might do to human health. We do know that right now the toll on aquatic life so far is over 45,000, including fish, crustaceans, and amphibians in a radius of several miles all around the crash site. Okay, so that's a little bit of a snapshot of some of the immediate and long-term consequences that we will see unfolding over the coming years. Right now, the main concern for humans is about the air and the water. And the air and public water systems are considered to be safe at this point for local residents, but people who live on wells are advised to do further testing and to use bottled water until they know more. I found a phone number to access free private water testing, and I will include that in our show notes. The suspect chemicals do tend to alter the color and taste of water, so that's a good warning sign.

0:11:25.2 RW: And common household filtering systems are effective for this kind of contamination. People are specifically advised against boiling suspect water, because this will make water vapor that is easily inhaled. And there are three main ways people can be exposed to whatever these toxic materials are that are lingering, and that's through drinking contaminated water or inhaling contaminated water vapor, and skin contact, as in bathing or doing dishes or anything else that causes us to be immersed in contaminated water. What other kinds of health problems are people close by the site experiencing? Well, here's the short list that I compiled from several local and national reports. This is information gathered from residents and first responders on the scene. They are dealing with chemical bronchitis, nausea, rashes, irritated and burning eyes, scratchy burning throat, headaches, and more. And the lack of accessibility in rural medicine isn't helping. The CDC and other agencies are now going door-to-door to gather information about what signs and symptoms people have, so I hope we will learn more about this as time goes on.

0:12:42.2 RW: Okay, so there's a little snapshot of what's going on in and near East Palestine. What does all this mean for our contributor? To review, here's a shortened version of what they sent. They said, "I'm wondering about what contraindications for massage there are in regards to chemical exposure. Can the people that were exposed safely receive massage therapy? Should I be protecting myself during these sessions?" People in East Palestine are searching for ways to support anxiety and stress relief during this time, and my heart says to donate a few massages, but then I started wondering if I would actually be doing a disservice to those who have been affected. It's so hard to say how massage may change the way these chemicals are metabolized. I think the biggest reported problem has been skin rashes, which are obviously a contraindication. Good, so let's take this on, one point at a time. Our contributor asks, "Can the people that were exposed safely receive massage therapy?" Well, you know what's coming as an answer to that question, right? It depends. Mainly, it depends on whether they can be comfortable on a massage table or chair regarding their breathing, and if their skin is healthy.

0:13:58.8 RW: They ask, "Should I be protecting myself during the sessions?" Well, I'm going to go out on a limb here and suggest that whatever effect these chemicals have on the skin, if the person has bathed in non-contaminated water, they probably can't spread any kind of a problem to someone else, so no, really, that is probably not going to be an issue. People in East Palestine are searching for support in anxiety and stress relief. Absolutely. And if you can offer that, that is a really good service, not only for the residents, but for any first responders or medical crews that might be involved in the accident site and follow-up cleaning up and care. Our contributor said, "It's so hard to say how massage may change the way these chemicals are metabolized." And I wanna say I understand your concern here, and as we've discussed, there are many unknowns in front of us about long-term consequences of this event, but whatever is happening with these folks metabolism of the chemicals they've been exposed to so far, I'm reasonably sure that massage won't have a major impact. That's all happening internally and at levels that are out of our reach.

0:15:07.7 RW: If they can exercise safely, they can probably receive most kinds of massage. But if they're affected by breathing problems, then maybe, maybe, massage might actually help a bit as they recover just by reducing unnecessary muscle tension in the breathing muscles. I do recommend pursuing this goal only after a client is on the mend, though. And yes, I agree that the biggest problem is rashes, and that situation needs to be resolved, of course, before someone gets massage over compromised skin. I wanna thank this massage therapist for submitting this question, which gave us all a chance to learn a bit more about chemical exposures and short and long-term risks to health. And I applaud their compassion and commitment to helping their community through this very difficult time.

0:16:00.2 RW: Hey everybody, thanks for listening to I Have a Client Who Pathology Conversations with Ruth Werner. Remember, you can send me your I Have a Client Who stories to ihaveaclientwho@abmp.com. That's ihaveaclientwho, all one word, all lowercase @abmp.com. I can't wait to see what you send me, and I'll see you next time.